Healthcare Provider Details

I. General information

NPI: 1548967672
Provider Name (Legal Business Name): LARRY WARD MCKEE JR. PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 KUEBLER DR
ROCHESTER NY
14624-3939
US

IV. Provider business mailing address

42 KUEBLER DR
ROCHESTER NY
14624-3939
US

V. Phone/Fax

Practice location:
  • Phone: 585-278-0477
  • Fax: 847-441-0734
Mailing address:
  • Phone: 585-278-0477
  • Fax: 847-441-0734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number007883-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: